NPIMap

Organization Active NPI

Mittal Kidney and Dialysis PC

  • Nephrology Physician
  • Cordova, TN
National Provider Identifier
1831201466
Registry record updated Sep 11, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
Nephrology PhysicianTaxonomy code 207RN0300X
License
32232
Legal business name
MITTAL KIDNEY AND DIALYSIS PC
Practice address
300 S Walnut Bend Rd Ste 12
Cordova, TN 38018
Phone
(901) 767-0101
Fax
(901) 767-0304
NPI assigned
Aug 31, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Sep 11, 2018

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Sanjeev Mittal, MDNPI 1689603102
Title
President
Phone
(901) 767-0101

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Nephrology PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 207RN0300X 32232 Primary

Addresses

Primary practice location

300 S Walnut Bend Rd Ste 12
Cordova, TN 38018

Mailing address

300 S Walnut Bend Rd Ste 12
Cordova, TN 38018
Phone (901) 767-0101

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in TN, MS2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20041110000180 TN Part B Supplier - Clinic/Group Practice 9830152958 Receives reassigned benefits from 7 practitioners
Practice locations: Cordova, TN
O20050112000822 MS Part B Supplier - Clinic/Group Practice 9830152958 Receives reassigned benefits from 7 practitioners
Practice locations: Southaven, MS

National Provider Directory

National Provider Directory
Tax ID family
Mittal Kidney and Dialysis2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

Locations

7620 Clarington Cv
#A
Southaven, MS 38671

7684 Airways Blvd
Southaven, MS 38671
Phone (901) 405-0275

7620 Clarington Cv
Southaven, MS 38671
Phone (901) 767-0101

7105 Swinnea Rd
Ste 1
Southaven, MS 38671

6027 Walnut Grove Rd
Ste 402
Memphis, TN 38120
Phone (901) 767-0101

Interoperability endpoints

  • FHIR API: https://fhir4.healow.com/fhir/r4/GCFDAA

Practitioners & affiliated clinicians

Practitioners 38

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

View all 38

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1156982400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1536624000000",
    "number": "1831201466",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "300 S WALNUT BEND RD STE 12",
            "city": "CORDOVA",
            "state": "TN",
            "postal_code": "38018",
            "telephone_number": "901-767-0101",
            "fax_number": "901-767-0304"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "300 S WALNUT BEND RD STE 12",
            "city": "CORDOVA",
            "state": "TN",
            "postal_code": "38018",
            "telephone_number": "901-767-0101",
            "fax_number": "901-767-0304"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MITTAL KIDNEY AND DIALYSIS PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-08-31",
        "last_updated": "2018-09-11",
        "status": "A",
        "authorized_official_last_name": "MITTAL",
        "authorized_official_first_name": "SANJEEV",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "901-767-0101",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207RN0300X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Internal Medicine, Nephrology",
            "state": null,
            "license": "32232",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Cordova, TN

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 11, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.